Healthcare Provider Details

I. General information

NPI: 1265734131
Provider Name (Legal Business Name): WASIM FAKHAR, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E BALTIMORE ST SUITE D
TANEYTOWN MD
21787-2300
US

IV. Provider business mailing address

417 E BALTIMORE ST SUITE D
TANEYTOWN MD
21787-2300
US

V. Phone/Fax

Practice location:
  • Phone: 410-756-2121
  • Fax: 410-756-2830
Mailing address:
  • Phone: 410-756-2121
  • Fax: 410-756-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0054580
License Number StateMD

VIII. Authorized Official

Name: WASIM FAKHAR
Title or Position: DOCTOR
Credential: M.D.
Phone: 410-756-2121